Doctoring & Healthcare

All Articles in the Category ‘Doctoring & Healthcare’

Vaccines, Profanity, And Professionalism

Screenshot 2015-02-01 12.30.40You’ve likely seen the Jimmy Kimmel “public service announcement” on vaccines. Over 3 1/2 million people have viewed it on Youtube so if you’re not yet one of them you’ll likely add to the tally now. The first 3 minutes of the monologue are spot-on and they’re also very funny. Jimmy takes a stand against the “anti-vaxxers.” He mentions that some parents are more scared of “gluten than small pox” and references the reality that some schools in this country have 20% of students opted out of some vaccines. His monologue is followed by a series of pediatricians voicing profane frustration. Most people think the video is hilarious and many of us fired up about vaccines feel a rush when the safety and trust we have in vaccines gets the spotlight like it does here. Jimmy’s script is brilliantly written and his execution is direct.

Thing is, I didn’t like the video. I was left feeling somewhat uncomfortable and embarrassed for my profession. Immediately I wanted to explain that even though many of us are frustrated with where we are on vaccine hesitancy, we really aren’t interested in offending. We will always work to partner with parents –we won’t mock, swear, or intimidate you. Our goal is to support, protect, and cure children whenever we can and our privileged responsibility is to listen to parental fear and connect families with resources that soothe. This really is why we went to medical school.

It’s exciting when celebrities voice-up and stand to talk about vaccine issues that reflect science. It’s especially exciting when they include practicing physicians. Counseling families who are hesitant or flat-out refuse vaccines is a part of the job for every pediatrician. A study published in the journal Pediatrics this week found 93% of pediatricians had reported they’d been asked by parents to skip or delay vaccines in the last month. The current measles outbreak has changed the tone of these conversations for many of us; I’ve written about my new stance because I’m enraged pockets of measles can even occur in 2015. That being said, even though I really do like to swear like these pediatricians when I’m out of public earshot, I’m unsure the tactic of this PSA will do any good for those parents who hesitate to immunize their children according to the tested and safe schedule.

It seems to me that if parenting is governed by love, pediatrics is governed by respect for that love and for the integrity of children individually.

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Cocooning For Measles

2-12 measles cocooningThe measles outbreak continues to spread, with 121 cases now reported in 17 states (CDC data as of February 6th). Many states are getting serious about detailing why exemptions for vaccines exist and looking at ways to better protect the population. This week in the Seattle Times three local pediatricians speak out for removing both personal choice and religious exemptions to protect the public and vulnerable children. And here, Dr Paul Offit writes about religious exemptions asking, “What Would Jesus Do About Measles.”

There’s no question vaccines are having their moment. We are working through tough questions. In the Seattle Times piece, Drs. Diekema, Opel, and Marcuse keenly point out:

We hold dear both freedom of choice and public health.

Finding an optimal balance is clearly of great import. This will take great advocacy and work to help continue to build trust in the MMR vaccine that is safe and highly effective at preventing measles infections.

Though I’ve been lucky enough to avoid seeing measles thus far in my medical education and career, this serious, uber-contagious disease has given some parents and caregivers pause when it comes to putting their unprotected (read: too young to vaccinate) infants in a situation where their health could be compromised. Many mothers have emailed, tweeted and Facebook messaged me asking how they can protect their little ones who haven’t received their vaccinations yet and my simple answer is this: cocooning. That is, provide a family of protection by having every single child & adult immunized against whooping cough, influenza, and other vaccine preventable illnesses. By surrounding a baby with only immunized people, you cocoon them against serious infections. Read full post »

Measles Outbreak With A Baby At Home

baby-O-e13075541951481Many parents around the U.S. are asking what to do about a possible measles exposure with a baby at home who is too young to be immunized. Should they stay home? Can they travel? Should they cancel that trip to Utah or to Vermont or even to Disney next month? Can they head out to the store without worry? Are they “safe?”

I hate that I can’t completely say they are safe. Measles is wildly contagious and during an outbreak it can spread, especially to older infants who aren’t vaccinated yet. The good news is that risk is low (more than 90% of us won’t get measles because we’re vaccinated so we also won’t spread it to you!). Some parents are also wondering about getting the vaccine before the baby turns 1 year because they’ve heard the recommendation for infants traveling abroad: infants traveling outside the U.S. are recommended to get an MMR (measles, mumps, rubella) shot if they are over 6 months of age (of note, babies who get the shot as an infant also get the usual shot again at 12 months of age). Without travel plans we wait to immunize babies with their first MMR vaccine until they are 12 months of age. Over 95% of babies who get the shot at 12 months of age are protected against measles and over 99% are protected for a lifetime after the 2nd dose (given at least 1 month later). Wow, right?

“This is not going to be the end-all-be-all post on protecting your infant or child from measles'” Dr Matthew Kronman, a pediatric infectious disease expert at Seattle Children’s, reminded me as we chatted today. Advice and guidance for protecting babies and children will change as we learn again how to protect our population from measles infection while unvaccinated pockets of people remain.

The CDC warns that the outbreak could grow (there’s over 100 cases in 14 states as of today) and nationally there’s a palpable dialogue going on between the herd (those immunized) and those not. Politicians are involved — Governor Christie talked today about “choice;” Obama is urging parents to immunize right along side the president of the American Academy of Pediatrics who released another urgent statement. Pediatricians, family docs, nurse practitioners and health workers everywhere are encouraging parents to get shots up-to-date to protect their own children and vulnerable populations (this includes infants).  Here’s a bit of evidence and information that can hopefully curb anxiety for parents to babies. I teamed up with Dr Edgar Marcuse, a lifelong scholar with vaccines, former pediatrician at Seattle Children’s and an emeritus professor of pediatrics at University of Washington and Dr Matthew Kronman. Here are 7 tips about infants and families that may help shape your thinking: Read full post »

Enraged By 2015 Measles In America

Screenshot 2015-02-01 12.30.40I wept at the end of the movie I watched last night, The Imitation Game. The reason really was this: it reminded me how we’re just so terrible to each other at times. How much suffering occurs when we don’t think things through. The movie wasn’t about measles or vaccination, but injustices in it pushed me to leave my Sunday morning with my children to share this:

My patience with vaccine hesitancy has pivoted. I’m embarrassed to say it took an outbreak of measles stemming at Disney to move me from impatient and passionate to hands-on-my-hips fired-up and disappointed. Today I feel a bit of outrage that unvaccinated families are not pounding on the door to get their MMR vaccine, even on Superbowl Sunday. In my mind they should be doing so selfishly (for personal protection) and they should be doing so altruistically (for others who really count on them). I expect both from the public.

Read Charlie and the Chocolate Factory author Roald Dahl’s 1988 message about his daughter’s death from measles — insane that it rings true today.

I feel somewhat enraged that many parents with babies in the United States are nervous right now about their infants getting measles. The chance is small but it shouldn’t even be a chance when there is a vaccine that is nearly 100% protective for those milling around these delicious babies. I’m angry because a friend of mine has a child who got measles when she was too young to be immunized. I’m enraged that children who fulfill their “Make A Wish” trip to Disneyland — after a liver transplant or after chemotherapy or after a tumor is cut out of their bone — must feel a little shaky making the choice to go there now. Can you imagine getting a short straw like a liver that didn’t work like it should or a childhood cancer diagnosis and then getting another one (increased measles risk) just when you’re elevated to celebrate your life? Read full post »

Wellness Visits: A Magical Place To Communicate

As 2015 gets earnestly underway, many of us are working to keep resolutions we made to better ourselves and our family as the new year continues to unfold. In case health is a part of your resolution or focus, here are a couple very quick reminders for check-ups and interactions at the doctor’s or practitioner’s office (3 tips below). I’m going to sound very much like a pediatrician here: wellness visits and check-ups add great value to preventing things. So much better than having to do the hard work of reversing problematic changes. This isn’t just about vitamins (which children don’t really need) and shots (which children wildly benefit from). This is about communication.

Well-Child Visits And Check-ups

1-28 CDC BMI chart

Courtesy of CDC

Wellness visits often get forgotten when things are going well (hurrah!) yet they serve a grand purpose on tracking health and wellness by working to create prompts and services that prevent illness. The numbers (from vision, hearing, height, weight, body mass index, and vital signs –blood pressure, temperature, respirations and pulse) help track trends and provide alerts. They help reduce bias in our thinking as parents and pediatricians. As parents we can have a tendency to both unintentionally ignore warning signs of health risks or over-analyze perfectly normal developmental phases. Case in point: half of parents of overweight/obese children underestimate their child’s weight. On the other end of the spectrum, 1 in 7 parents believe their normal-weight child is too skinny. As a reminder, reading a growth grid has a lot less to do with numbers than it does trends. The import lies in following lines; is your child tracking, are they growing at the right rate, do they deviate or “fall-off” the curve? Here’s a quick video where I explain how to interpret the growth grid if you want to learn more.

Importantly, these visits also facilitate a place to bring up the questions that nag at you. Often those things are about habits, sleep, anxiety, body size/shape, school work or mood — or just how a child sees the world. Use the prevention visit to squelch anxiety of your own. What parent doesn’t have something pulling on their sleeve of worry while raising another human? The task of parenting is always somewhat monumental and the job description is always shifting as our children grow. The stakes are high when a child’s life is guided by another. Read full post »

Winter Skin And Itches That Rash

OTC-Dry-Skin-Infographic_FinalLiving in the northwest it’s easy to forget the sun exists during the winter. Most days are dim, usually drizzly and almost always cloud-covered. It’s easy to remember to take care of your skin when your arms and legs are playing in the warm rays of the sun but when you’re bundled under scarves and rainwear, our self-care falters. We care for our children’s skin often better than our own. Winter brings a slew of skin harms with it. Giving your skin the TLC it needs during these dark months will keep it healthy (and looking great) once it’s time again for spring exposure.

Dry Skin And “The Itch That Rashes”

Our skin gets dry in the winter for a variety of reasons. Cold temperatures, lack of humidity and recirculated air (hello office heater!) can all contribute to dry, scaly spots. Winter is also a time when we see an increased risk for eczema flare-ups, a chronic, relapsing condition that brings incredibly dry, itchy patches of skin. The icing on the cake is that eczema primarily affects kids! A recent study suggests at least 10% of children in the US suffer from eczema, the “rash that itches.” A patch gets started, a child can’t help but itch it and the rash blooms. Between 2000 & 2010 pediatric cases of eczema came close to doubling and while this condition not only affects how skin looks and feels, it can have a direct impact on a child’s quality of life. Nearly half of kids with eczema report a severely negative impact on their quality of life, including sleep deprivation (from the itching), activity restriction and even depression. If your child suffers from eczema, talk to your pediatrician to create an action plan for combating these dry months and hopefully avoiding such severe tolls and trolls on everyday life.

Protecting Your Skin Year Round

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Power Of A Kiss And Family Oral Health

Image courtesy: American Dental Association

Image courtesy: American Dental Association

Oral health doesn’t start and end with the dentist. Times are changing as the Washington Dental Service Foundation has trained 1,600 pediatricians and family physicians throughout the state on the importance of oral hygiene in young children. Pediatricians are now applying fluoride during well-child check-ups and counseling families more comprehensively on how to prevent dental decay while also referring to dentists for prevention and acute dental problems. Just last month I attended the 1-1/2 hour oral health training with a pediatric dentist. That learning coupled with a new policy statement from The American Academy of Pediatrics highlighting the importance of oral health inspired me to get the word out. I suspect we can all do a bit better protecting our children’s mouths. Recommendations for fluoridated toothpaste have recently changed (use it with the very first baby tooth!) as has knowledge and reminders about how we share our bacteria with our children. What we do for our mouth may have direct effects on our children’s.

The Most Common Chronic Childhood Disease

  • The facts about oral health in children are a little surprising. By their first birthday 8% of toddlers have cavities in their mouth and the Pediatrics policy detailed 24% 2-4 year-olds, 53% 6-8 year-olds and 56% 15 year-olds also have dental disease. Since oral health (even in babies and toddlers) is an integral part of overall health of children this is problematic. Dental disease has strong links between diabetes, respiratory infections and heart disease. The numbers for children with dental disease are high (!!) which makes dental disease the most common infection of childhood.
  • Good news is much of this disease can be prevented (or corrected) and because infants and young children see the pediatrician more frequently than the dentist, it’s becoming clear that pediatricians need to hone skills on oral health, the disease process, prevention and dentist interventions when necessary.

4 Things I Learned About Oral Health

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5 Things You Should Know About Concussions

This is a post authored by J. Forrest Bennett, ARNP who works in the rehabilitation department and on the concussion team led by Dr Samuel Browd (@DrBrowd), medical director of Seattle Children’s Sports Concussion Program. Forrest has had the unique experience to care for children after concussions in the immediate time after injury and in weeks to months thereafter when symptoms are prolonged. His wisdom can help us all understand the opportunity we have to improve children’s recovery after a head injury. In this post he explains what happens to the brain cells during a concussion, what constitutes risk for concussions, and the 5 things all of us need to know about concussions. I certainly know more after reading this and suspect you will too. Please leave comments or questions if you have them. Click here to read the first post in this series. 


Soccer is the highest risk sport for school-age girls.

Soccer is the highest risk sport for school-age girls.

What Happens During A Concussion?

A concussion is a complex process affecting the brain, brought on by biomechanical forces (like a blow to the head, car crash, etc.) The force is transmitted to the head and can result in usually short-lived symptoms such as headaches, brief loss of consciousness, nausea, and/or dizziness. These symptoms are believed to be due to a temporary shift in the neurotransmitters (chemicals that allow cells to communicate) in the brain, resulting in a mismatch where the brain needs more energy but receives decreased blood flow to the brain temporarily. This mismatch in blood flow is believed to last up to 10 days following an injury and helps explain the symptoms associated with a time-limited injury such as a concussion.

Unfortunately this also explains why diagnosing and managing concussions can be vexing. Unlike a broken bone, we do not have validated imagining or blood tests that enable definitive diagnosis. The best practice of diagnosing concussion currently relies on obtaining a detailed history and physical following an injury. Depending on the severity of the injury and initial presentation, a sideline assessment should performed to look for common post-concussive symptoms. If the initial injury is more severe one may need to be evaluated in the emergency department and imaging may be obtained to help rule out a more severe injury. Each traumatic brain injury is unique, and should be treated with respect. There is nothing more heart breaking than a traumatic injury being improperly respected and identified, leading to a delay in care and permanent deficits.

 It can be challenging to determine which concussions are mild, severe and which may progress. Ultimately the goal is to prevent injuries, screen for potential head injuries when appropriate and diagnose and treat injuries in a timely fashion to limit their severity.

How To Prevent Head Injuries

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The Seriousness Of Concussions

J. Forrest Bennett, ARNP, Rehabilitation

J. Forrest Bennett, ARNP, Rehabilitation

This is a guest post from J. Forrest Bennett, an ARNP at Seattle Children’s and Dr Samuel Browd (@DrBrowd) a neurosurgeon who, together with their team, care for children after concussions. Clearly, we’ve all heard more about concussion these past few years. Not just because of pro-football tragedies and lawsuits but also because of the increasing expertise the medical community is acquiring around how to care for children and young adults after getting hit in the head. We’re also learning how to prevent head injuries in the first place. Forrest and I first started discussing this last spring when I began to see his passion in getting great information out to families. He’s convinced the more we parents (and community physicians) know about what to do with head injuries the less children suffer. In some cases what we do in minute 1 or day 1 after an injury can really change how a child recovers. Take a peek at this awesome post and please post comments/questions if you have them. More content will also be published later this week.


There is an ongoing debate about how we should best assess, manage and prevent head injuries in sports. Given the complexity of the injury and the effects that a concussion can have on an individual there is no room for the outdated and dismissive terms such as “getting your bell rung” or a “ding to the head.” Being dismissive of head injuries can lead to premature return to play and can end tragically. These injuries really matter.

This isn’t to say that kids shouldn’t play sports of course. Sports promote cardiovascular health and play a crucial role in the character development of children and adolescents. Parents must balance the risk with the benefits of sports to promote healthy decision-making. I like to talk about an active risk-reduction lifestyle. Through outreach and education we can prevent debilitating injuries, identify concussions early, and provide care plans that stem from evidence to limit the impact injuries have on kids.

What Every Parent Should Know About Concussions

  • Helmets do NOT protect against all concussions
    • Helmets provide crucial protection against skull fractures and more severe brain injuries but you can still suffer a concussion even with all of the proper protective equipment.
  •  There is a right way to play sports
    • Teach your kids safe ways to play sports and adhere to the rules of the game. For example: no tackling in soccer and no head tohead contact in football. HEADS UP trained coaches teach actively safe participation in sports.
    • The majority of sport rules are intended to maintain a level playing field and enjoyable experience. Head to head contact in football is just one example of improper and unsafe play that has recently drawn national attention in increasing ones risk for injury.

Because injuries happen, a group of experts developed the Standardized Concussion Assessment tool- 3rd edition (SCAT 3). This tool can help guide trained coaching staff, athletic trainers and medical providers in the initial assessment, triaging, and monitoring of these injuries. Many concussions can be handled through the expertise of your pediatrician or primary care provider. Concussions with prolonged symptoms (lasting weeks to months) and\or more severe injuries frequently benefit from a team approach. Read full post »

Is Overuse Of Antibiotics The New Global Warming?

Desinfecting.JH

Antibiotic resistance is like global warming; it feels like it’s someone else’s problem to solve and much bigger than all of us. Yet the simple choices we make – whether or not to use antibiotics and which ones we pick – do affect us and our community. ~Dr Matthew Kronman

This week is Get SMART About Antibiotics Week, aimed at raising awareness of antibiotic resistance and the importance of appropriate use. Dr Kronman’s “inconvenient truth” reminder serves up the importance of our choices; what we do everyday with our food and our medicines changes not only our own health but also the health of others now and in the future. Antibiotics in food, water, and our clinics and hospitals change our environment. Each dose of antibiotics given to our children, ourselves, or the animals we eat change our community’s health in general. The more we use antibiotics that kill off susceptible bacteria, the more we select bacteria for survival that are resistant to known treatments. The consequence over time for us all is that there are more resistant bacteria or “superbugs” around causing harder to treat infections.

 4 Things You Can Do Today To Avoid Excess Antibiotics

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